Abstract
Abstract Comprehensive intersectoral and participatory strategies are required for successful implementation and functioning of local health promotion governance across Europe. 12 experts from 7 European countries took part in the two-stage online Delphi survey. 22 theses on key topics of municipal health promotion, prepared in a participatory process through interviews and a workshop with experts, were rated on a 10-point Likert scale (strongly disagree - strongly agree), and the confidence in answering and comments was queried. This procedure was repeated in the 2nd round. The response behaviour of the participants from the 1st round was made transparent to enable changes in opinion. In the quantitative analysis, the distribution of thesis rating was determined. The extent of consensus building was determined by comparing standard deviations. The comments were evaluated and summarized by content analysis. The outcome of the Delphi survey represents consensus-generated recommendations for the creation of healthy living environments in the municipal context. Consensus was reached on most of the theses. The experts agree on the need for an open structure of networks (mean 9.2; SD 0.6), a common vision in these networks (mean 8.3; SD 0.8), the resources required for organizing participatory processes (mean 9.5; SD 0.9) and the responsibility of all political areas for implementing an overall municipal strategy (mean 9.1; SD 0.8). The qualitative analysis provides indications that certain theses are assessed differently due to country-specific experiences and conditions. The results of the Delphi study provide a clear direction for generating recommendations. Depending on context and country, some contents are evaluated differently, which should be taken into account for the recommendations. In total, the study identified recommendations with cross-national validity that are beneficial for the creation of health promoting structures at local level.
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